Swallowing is a complex process involving over 30 muscles and nerves working in careful coordination to move food and liquids from the mouth to the stomach. When this process is disrupted, it can lead to dysphagia, or difficulty swallowing. Understanding the potential reasons behind this struggle is the first step toward finding relief.
The Two Main Types of Dysphagia
To pinpoint the problem, doctors categorize dysphagia based on where the issue occurs.
Oropharyngeal Dysphagia
This type affects the initial phase of swallowing, specifically the transfer of food from the mouth to the throat. Problems here can cause coughing, choking, or the sensation that food is going down the “wrong pipe”. Common causes include neurological disorders, muscle weakness, structural issues like Zenker's diverticulum, and age-related muscle deterioration.
Esophageal Dysphagia
This type involves problems in the esophagus, the muscular tube that carries food to the stomach. It often feels like food is stuck in the chest or the base of the throat after you've started to swallow. Potential causes include GERD, achalasia, esophageal spasms, eosinophilic esophagitis, and esophageal tumors.
A Comparison of Dysphagia Causes
| Cause Category | Common Conditions | Location of Problem | Key Symptoms |
|---|---|---|---|
| Neurological | Stroke, Parkinson's, ALS, MS | Oropharyngeal | Choking, coughing during meals, aspiration |
| Muscular | Achalasia, Scleroderma, MD | Esophageal (motility) | Sensation of food sticking, food backing up |
| Inflammatory | GERD, Eosinophilic Esophagitis | Esophageal | Heartburn, chest pain, tightening |
| Obstructive | Strictures, Tumors, Rings | Esophageal | Food feeling stuck in throat or chest |
| Structural | Zenker's Diverticulum | Oropharyngeal | Bad breath, gurgling noises, regurgitation |
When to See a Doctor
While occasional trouble swallowing may be benign, persistent or worsening symptoms should prompt a medical evaluation. Seek medical help if you experience unresolved swallowing problems, frequent coughing or choking while eating, unexplained weight loss, the sensation of food being stuck, progressively worsening difficulties, or if a blockage makes it hard to breathe (in which case seek immediate emergency help).
Diagnosis and Treatment Options
Proper diagnosis is key to effective treatment. Your doctor may perform tests such as a modified barium swallow study (MBS), upper endoscopy (EGD), or esophageal manometry to assess your swallowing function and identify the problem.
Treatment depends on the underlying cause and severity. Options include diet modification, swallowing therapy with a speech-language pathologist (SLP), medication for conditions like GERD or eosinophilic esophagitis, and procedures or surgery for strictures or achalasia.
At-Home Lifestyle Adjustments
Lifestyle adjustments can also help manage dysphagia symptoms. These include chewing thoroughly, staying upright while eating and for 30 minutes afterward, avoiding distractions during meals, staying hydrated (potentially using liquid thickeners as advised by a therapist), and avoiding triggers like caffeine and alcohol.
Conclusion
Difficulty swallowing, or dysphagia, can have various causes, ranging from common issues like GERD to neurological or structural problems. While simple adjustments may help mild cases, persistent or worsening symptoms require evaluation by a healthcare professional to rule out serious conditions and develop a treatment plan. Early diagnosis is crucial for managing dysphagia and preventing complications like aspiration pneumonia, malnutrition, and dehydration.
